Geographic atrophy (GA) is the advanced stage of age-related macular degeneration. While certain factors, like age and genetics, can increase your risk, others, like not smoking, may help slow or prevent it.

GA is the late stage of age-related macular degeneration (AMD).

AMD is a progressive eye disease, which means that it gets worse over time. AMD damages the macula, the part of your retina that gives you clear, straight-ahead vision.

The disease has three stages:

  • early (dry)
  • intermediate (dry)
  • late (dry or wet)

Atrophy is when cells in your retina waste away, causing blind spots in your vision. Geographic refers to the sharply defined regions of the damaged retina. It can lead to permanent vision loss.

Only some people with AMD develop GA. Keep reading to learn about factors that increase the risk of AMD and condition progression.

Age is one of the most significant risk factors for AMD and GA. The average age of people with GA is 79 years.

The retina changes with age in ways that increase the risk of damage.

AMD can run in families. The genes you inherit from your parents not only affect your risk of getting AMD but also of it developing into GA.

Researchers have found several gene variants linked to AMD progression. These include genes involved with inflammation, cell survival, and fat transport in the body.

Learn more about AMD and genes.

Smoking not only contributes to heart disease, cancer, and lung disease. It’s also harmful to your eyes.

Smoking can double or even quadruple your risk for any stage of AMD. GA also progresses faster in smokers than in nonsmokers.

Tobacco smoke contains toxic chemicals that damage the retina as it travels through its blood vessels. Smoking also contributes to oxidative stress, which is an imbalance between harmful molecules called free radicals and the antioxidants that help your body fight off free radicals.

The more you smoke, the greater your AMD risk. But 20 years after you quit, your risk may be the same as that of someone who never smoked.

Rates of AMD differ by ethnic background.

White people of European descent have higher rates of AMD than people of other ethnicities. One reason may be that they have less melanin, a pigment that filters sunlight and protects the retina from damage. Genes are another possible reason for the difference in AMD rates.

Asian people often have a different type of AMD. They have fewer drusen, which are yellow deposits that damage the macula in AMD. Researchers found that in most Asian people, the disease progresses more slowly than in people of other ethnicities.

Having a high body mass index (BMI) might increase the risk of AMD and its progression. Some research has found a connection between BMI and AMD, but not all research has found this correlation.

Having one of these diseases might increase your risk for AMD and GA:

  • Cataracts: Some studies suggest cataracts and the surgery to remove them increase the risk for AMD and speeds up its progression. Cataracts and AMD also share common risks like age, smoking, and obesity.
  • Chronic kidney disease: Some studies suggest a link between AMD and chronic kidney disease, while others do not. As with cataracts, the two conditions may share common risks like age and inflammation.
  • High blood pressure: Consistently high blood pressure damages blood vessels, including ones that nourish the retina. Yet, no evidence shows that treating high blood pressure reduces the risk of AMD progression.
  • Hyperthyroidism: An overactive thyroid gland produces too much hormone. Excess thyroid hormone may speed up the body’s metabolism, which could increase damaging oxidative stress.
  • Obesity: While excess weight doesn’t seem to affect early AMD risk, obesity may increase the risk of developing advanced AMD.

Learn more about the risk factors for AMD.

Antioxidant-rich foods like fruits and vegetables buffer the harmful effects of free radicals on the eyes. Fatty fish like salmon and tuna are high in healthy fatty acids that might also be protective.

Investigations and studies have taken place into whether the Mediterranean diet can slow AMD. Research from 2022 suggests that people who closely follow a Mediterranean diet, which is high in eye-protective nutrients, are less likely to develop AMD or progress to late-stage AMD.

Conversely, eating foods with a high GI seems to increase the risk of AMD progression. The glycemic index measures how much certain foods raise blood sugar. Examples of high-GI foods include:

  • white bread
  • white rice
  • cookies

Learn more about eating right for dry AMD.

According to a 2020 review, having at least a high school diploma is linked to a lower risk of early and late AMD. However, education itself is probably not to blame for this eye disease.

Instead, factors like smoking and an unbalanced diet may be responsible for the increased risk.

People who spend more time outside in sunlight are more likely to develop AMD. Sunlight contributes to oxidative stress on the retina, yet researchers don’t know how much sun exposure causes AMD progression.

Here are some lifestyle changes you can make to lower your risk for AMD and GA:

  • Eat more greens: Dark, leafy greens like spinach, kale, and collard greens contain the plant pigment lutein, a carotenoid that protects the retina against sun damage.
  • Avoid using tobacco: Even if you have a history of tobacco use, your AMD risk decreases the longer it’s been since you quit. If you currently use tobacco products, quitting can reduce your risk of AMD and other health conditions.
  • Maintain a moderate weight: A doctor may recommend methods to help you lose weight or maintain a moderate weight to reduce your risk of AMD progression.
  • Eat fatty fish: Salmon, tuna, and sardines are high in healthy omega-3 fatty acids that protect the eyes.
  • Wear sunglasses: Sunglasses that protect from ultraviolet A (UVA) and ultraviolet B (UVB) light may benefit your overall eye health.

Regular appointments with an eye doctor for regular checkups can help prevent vision problems before they start.

A doctor may also recommend the AREDS vitamin formulation to lower the risk of early AMD turning into late AMD.

Medications to slow GA progression

If you have late AMD or GA, a doctor may recommend treatment to reduce the risk of progression. Two medications, Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol), approved in 2023, may help slow the progression of GA.

You can talk with a doctor to learn about whether these medications may help slow the progression of GA.

Learn more about the best treatment for GA.

GA is the advanced stage of AMD. A few factors could make you more likely to develop late-stage AMD. You can’t change some factors, like your age, gender, and ethnicity, but you may have some control over others, such as diet and sun exposure.

Your eye doctor can talk you through your AMD risks. They can also give you advice on how to preserve your vision as you get older.